Opinion statement

The use of cacao for health benefits dates back at least 3000 years. Our understanding of cacao has evolved with modern science. It is now felt based on extensive research the main health benefits of cacao stem from epicatechin, a flavanol found in cacao. The process of manufacturing dark chocolate retains epicatechin, whereas milk chocolate does not contain significant amounts of epicatechin. Thus, most of the current research studies are focused on dark chocolate. Both epidemiological and clinical studies suggest a beneficial effect of dark chocolate on blood pressure, lipids, and inflammation. Proposed mechanisms underlying these benefits include enhanced nitric oxide bioavailability and improved mitochondrial structure/function. Ultimately, further studies of this promising compound are needed to elucidate its potential for prevention and treatment of cardiovascular and metabolic diseases as well as other diseases that have underlying mechanisms of mitochondrial dysfunction and nitric oxide deficiency.

Kowk C, Boekholdt SM, Lentjes MA, Loke YK, Luben RN, Yeong JK, et al. Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women. Heart. 2015;101(16):1279–87. This large analysis of dark chocolate consumption is the most recent data on the topic and suggests that consumption may be related to lower blood pressure. Their paper also includes a meta-analysis of nine separate studies that found an association with dark chocolate and decreased risk of various cardiovascular conditions.CrossRefGoogle Scholar

Ortiz-Vilchis P, Yamazaki KG, Rubio-Gayosso I, Ramirez-Sanchez I, Calzada C, Romero-Perez D, et al. Co-administration of the flavanol (-)-epicatechin with doxycycline synergistically reduced infarct size in a model of ischemia reperfusion injury by inhibition of mitochondrial swelling. Eur J Pharmacol. 2014;744:76–82. An assessment of the potential cardioprotective effects of epicatechin in an in vivo rat model. This was the first study to suggest that epicatechin may confer benefits through inhibition of the mitochondrial permeability transition pore (mPTP), which is now a major focus of research.CrossRefPubMedGoogle Scholar

Taub PR, Ramirez-Sanchez I, Ciaraldi TP, Perkins G, Murphy AN, Naviaux R, et al. Alterations in skeletal muscle indicators of mitochondrial structure and biogenesis in patients with type 2 diabetes and heart failure: effects of epicatechin rich cocoa. Clin Transl Sci. 2012;5(1):43–7. This was the first study of the role of epicatechin on mitochondria in a population at high risk for cardiovascular events. The analysis suggested the beneficial effects of epicatechin upon mitochondria structure and function, analyzed via assessment of skeletal muscle changes and mitochondrial protein levels.CrossRefPubMedGoogle Scholar

Brickman AM, Khan UA, Provenano FA, Yeung LK, Suzuki W, Schroeter H, et al. Enhancing dentate gyrus function with dietary flavanols improves cognition in older adults. Nat Neurosci. 2014;17(12):1798–803. This illustrates a promising new area of epicatechin research within neurology and cognitive-behavioral sciences. There will likely be more data over the next few years related to epicatechin and effects on cognitive function and other neurological pathways.CrossRefPubMedGoogle Scholar